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There are four prominent endocrine and metabolic disorders that not only contribute to obesity, but also make weight loss difficult. These conditions – “bad metabolism,” hypothyroidism, an underactive thyroid, and “adrenal fatigue” – are frequently misdiagnosed by doctors, or incorrectly self-diagnosed by patients. As a result, healthy people may think that they have them, while truly affected – may miss them. Both groups suffer needlessly. Let’s review some of the long-held misconceptions about this paradox.
The first misconception is about “bad metabolism,” and it is the most common, approaching a near 100% popularity. Medically and nutritionally speaking, it is a complete opposite. What you may think is “bad” is, actually, “good,” and here is why.
Bad Metabolism
The truly “bad” metabolic disorders concern water balance and fluid volume; the balance of electrolytes (sodium, potassium, calcium, magnesium, and phosphate); acid-base regulation; disorders of carbohydrate metabolism, such as hypoglycemia, type 1 and type 2 diabetes, diabetic and alcoholic ketoacidosis; and lipid disorders, such as dyslipidemia and hypolipidemia [1].
These conditions affect people of all ages, genders, and body weights. Some of them are outright deadly, while others – such as diabetes or dyslipidemia – are chronic. Within the same group of conditions, some are associated with obesity, such as prediabetes and type 2 diabetes. Others, such as type 1 diabetes or diabetic ketoacidosis, result in profound and life-threatening weight loss.
Consequently, any time you mention “bad metabolism” in relationship to your weight, your doctor will know exactly what you mean, but may still chuckle at your misinterpretation. And if you continue insisting that you may have it, he or she may also tell you that when it comes to body weight, a true “bad metabolism” is a sign of impending death, and that a precipitous weight loss, not gain, is one of its primary symptoms.
The emaciated gentleman on the left is Steve Jobs of Apple fame, shortly before his premature and unfortunate death. Take a hard look at this heartbreaking picture. That is what an actual “bad metabolism” – meaning the body’s inability to properly metabolize nutrients essential for life – really looks like.
Not so long ago, the dominant thinking and attitudes toward metabolism was a complete opposite. When my mother met my dad, a tall and handsome man with manners to match, she was short and moderately overweight, with big hips and large breasts, an ideal body shape for the 1950s. Single men would look at her thinking: “Gosh, this lady is so attractive! I want her to become my wife and the mother of my children.”
Today’s young men, conditioned by the Victoria Secrets’ standards, are more likely to pass over someone like my mother in favor of a waifish girl like Calista Flockhart (32A-23-30), who just three generations ago would have had a hard time finding a marriage partner because of prejudices typical for that era:
- Her appearance would reflect probable malnutrition or chronic illness throughout early development. In that rough era of near-zero upward mobility, malnourished children came predominantly from impoverished households, and no man or woman wanted to marry into a poor family.
- Before the near universal availability of on-demand C-section, her narrow hips would be considered life-threatening during natural childbirth.
- Her small breasts would be assumed inadequate for motherhood because she might have difficulties breastfeeding her numerous offspring. This isn’t, really, entirely correct, but that’s, unfortunately, how it was and still is in undeveloped societies.
- Back then, her small body would be deemed too weak to chop wood, milk cows, carry buckets of water, and cook, clean, and wash from dawn to dusk for the entire family.
- Personality-wise, a person of her shape would be considered a “cold fish” because underweight women have lower levels of estrogen and are believed to be not as libidinous as normal weight or, even better, overweight women. I don’t know if that is true, but that’s how it was.
All of that primitive, misogynistic, and mostly unconscious thinking – to find a partner who will last you and your children through thick and thin – was, essentially, a basic “animal” instinct in action, honed over hundreds of thousands of years of pragmatic and merciless natural selection.
Naturally, that’s exactly what my father did without giving it a second thought – he married a woman with a good metabolism. He knew instinctively what my mom’s doctor told her after every check-up: “Polina, you have a fantastic metabolism!” For her generation it was an asset, not a curse. (The photographs of my parents on the right are from 1958, four years after my birth. They are, respectively, 43 and 37 years old).
True to form, my mother had an accidental pregnancy at the age of 45, while the usual rate of conception after age 40 is less than 5%. And that is after surviving the horrors of starvation and backbreaking labor during the four years of World War II as well as the devastation of postwar Russia.
Calista Flockhart, on the other hand, finally married actor Harrison Ford at the age of 46. In all probability, natural selection wasn’t on the mind of Mr. Ford, who at the time of their marriage in 2010 was already 68 years old. The couple is raising her adopted son Liam, who was born in 2001. Any way you look at it, the laws of evolution remain as tough today as they have ever been, even to someone as beautiful, talented, and famous as Ms. Flockhart.
So, if you too are endowed with a good metabolism just like my mother was, the problem isn’t with you, your genes, or your body, but with the times we are living – the sum of abundant food, minimal physical exertion, and all conceivable creature comforts is behind obesity epidemics on one hand, while the incorrect believe into “bad metabolism” causes many people to drop their weight loss diets too soon, or discourages them from considering one in the first place.
THE TAKEAWAY: Since it’s too late to get another set of genes, or become a lumberjack, or give up comforts, concentrate on the two factors that are still under your total control – what you eat and how your “burn” it! In fact, your “good metabolism” will work in your favor – the better it is, the faster you are going to lose weight.
Hypothyroidism and underactive thyroid
The situation with thyroid-related disorders is a lot more complicated than with bad metabolism. A true “underactive thyroid” – a vernacular for subclinical hypothyroidism – affects up to 10% of women and 6% of men, many of them over 65 years of age. The rate of clinical hypothyroidism is under 1.2% of women and 0.4% of men [2] predominantly among older adults, 33.3% of adult Americans are overweight and 35.9% are clinically obese, or 69.2% .
As you can see, the number of overweight people is significantly greater than the number of people affected by subclinical or clinical hypothyroidism [3], even though many people who are affected by adiposity – a shorthand for “overweight or obese” – believe they may have this condition because of weight loss resistance or weight gain on a moderate diet.
On the opposite side of the spectrum, there are people who are misdiagnosed and untreated because both conditions are challenging to manage even to specialists. According to The Merck Manual of Diagnosis and Therapy, the early stages of this condition are associated with the following symptoms:
“…cold intolerance, constipation, forgetfulness, and personality changes. Modest weight gain is largely the result of fluid retention and decreased metabolism. Paresthesias [tingling – KM] of the hands and feet are common, often due to carpal-tarsal tunnel syndrome…[4]”
Please also note one significant detail in the above quote: “Modest weight gain is largely the result of fluid retention…” This explains why some people who are affected by this condition can’t lose weight even on a very low calorie diet – most of that extra weight comes at the expense of water, not body fat.
Women with hypothyroidism may also be affected by menorrhagia – an abnormally heavy bleeding during menstruation, or amenorrhea – an abnormal absence of menstruation. If you are experiencing any of these symptoms, get evaluated by a board certified endocrinologist.
Because clinical hypothyroidism isn’t as common as some other disease, non-specialists may not be able to properly diagnose and treat you, especially during the earlier stages while the symptoms are still subtle, and the tests aren’t as definitive. If your diagnosis or treatment outcomes are not satisfactory, you may also consider working with alternative providers.
Things get even more complicated with Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis. It is an autoimmune inflammatory condition of the thyroid. In addition to the transient symptoms of hypothyroidism during early stages, it is distinguished by painless enlargement of the thyroid gland, and, in some cases, a feeling of fullness in the throat. It may or may not be associated with adiposity.
The prevalence of Hashimoto’s thyroiditis ranges from 0.1 to 0.15% of the population (1 to 1.5 cases per 1,000 people), and it affects women 10 to 20 times more often than men. It is most common between the ages of 45 to 65, and it often runs in families (i.e. it has a genetic component).
The same immune mechanisms which cause Hashimoto’s thyroiditis may also cause Graves’ disease (thyroid enlargement, goiter), Addison’s disease, type 1 diabetes, celiac disease (an autoimmune inflammation in the small intestine), vitiligo (skin depigmentation), premature graying of hair (same mechanism as in vitiligo), pernicious anemia, and connective tissue disorders.
If you suspect that you may have Hashimoto’s thyroiditis, GET TESTED. The level of thyroid hormones T4 and TSH may remain normal during early stages, making its diagnosis difficult in non-specialized clinical settings. Seek out a specialist trained in diagnosing and treating this relatively rare condition. 1 case in 1,000 is, indeed, rare for an internist who treats on average 2,000-3,000 patients a year, and may not encounter a single patient with Hashimoto’s in years.
I do not recommend commencing any type of weight loss diet until you are properly diagnosed and treated for hypothyroidism. A reduced calorie diet may deny your body from getting essential nutrients, and may exacerbate the progression of the disease. Besides, it isn’t likely to be effective anyway because of fluid retention.
As clinical hypothyroidism progresses, the symptoms become more severe and obvious, including precipitous weight loss. You can learn more about other manifestations of clinical hypothyroidism in countless online resources.
THE TAKEAWAY: Do not rely on outdated misconceptions about clinical and subclinical hypothyroidism. If you are experiencing any symptoms related to either condition, seek out the best treatment money can buy. Continuous weight gain in healthy people isn’t always a symptom of hypothyroidism. As epidemiological statistic – however flawed it may be – demonstrates, the majority of people with adiposity are not affected by hypothyroidism. If you are in this fortunate majority, you earlier failures to lose weight weren’t related to bad health, but to bad diets.
Adrenal fatigue
What you may think is “adrenal fatigue” endocrinologists call primary or secondary adrenal insufficiency. Both conditions are ascertained by a blood test, and treated, when necessary, with appropriate medication.
Primary adrenal insufficiency – also known as Addison’s disease – is a hard to miss condition because it is accompanied by severe skin pigmentation. Its prevalence – a medical term for the number of affected people – is less than 1 person in 14,000 (<0.007%) in population [5]. Just like truly “bad metabolism,” it causes weight loss, not gain:
“The slowly progressive loss of cortisol and aldosterone secretion usually produces a chronic, steadily worsening fatigue, a loss of appetite, and some weight loss. Blood pressure is low and falls further when a person is standing, producing lightheadedness. Nausea, sometimes with vomiting, and diarrhea are common. The muscles are weak and often go into spasm. [6]”
If you have any of the above symptoms, get tested immediately. This debilitating condition can be well controlled with medication.
The prevalence of secondary adrenal insufficiency is less than 1 person in 3,600, or 0.027% of the population. The symptoms of this condition are similar to Addison’s disease, but without pigmentation. Again, a blood test is required to screen it out and receive an appropriate and effective treatment.
A popular opinion exists that this condition may be substantially underdiagnosed. It may very well be correct, so let’s assume that there are 100 times more people affected by secondary adrenal insufficiency than what epidemiologists are telling us. Alas, it still comes to only 2.7%, a drop in the bucket next to 69.2% of the population with adiposity.
THE TAKEAWAY: Just as with “bad metabolism” and hypothyroidism, don’t rely on outdated misconceptions about “adrenal fatigue” and its relations to weight loss or gain. Seek out expert help to screen out primary and secondary adrenal insufficiency, and, if necessary, obtain adequate treatment.
References
[1] Endocrine and Metabolic Disorders; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[2] Vanderpump, Mark P.J., “The epidemiology of thyroid disease.” (2011) : 39-51. [link]
[3] This calculation is based on the following numbers: percent of adults age 20 years and over who are obese: 35.9% (2009-2010); percent of adults age 20 years and over who are overweight (and not obese): 33.3% (2009-2010). Source: Department of Health and Human Services, Health, United States, 2011, by Kathleen Sebelius, et. al., 2011, [link to PDF]
[4] Hypothyroidism; Symptoms and Signs; The Merck Manual of Diagnosis and Therapy, online edition; Last accessed March 30, 2013; [link]
[5] Division of Medical Sciences, University of Birmingham, and Department of Medicine, Endocrine and Diabetes University of Wurzburg, “Adrenal Insufficiency,” Lancet, 361 (2003): 1881-93; [link to PDF]
[6] Margulies, Paul, MD; National Adrenal Diseases Foundation; Addison’s Disease – The Facts You Need To Know; “What are the symptoms of Addison’s Disease?” Last accessed March 30, 2013; [link]
Previous posts from the “Why Diets Fail?” series:
1. The Real Reason Diets Fail and What You Can Do About It
2. How Long Will It Take Me to Lose the Weight?
3. Why One Calorie For Her Is Half a Calorie For Him
For your health and safety, please read these important Weight Loss Common Sense Warnings and Disclaimers before commencing a reduced calorie diet.
Sarah, you may have just alienated some of the people you intended to help by allowing Mr Monastyrsky to post on your blog. I am about 25 lbs overweight however, I do not tell people that I am overweight for any of the reasons your guest listed. I overeat due to a number of factors and I’m not as active as I should be – but I am constantly working to improve both of these factors. I have not and do not tell people that I have hypothyroidism, a slow metabolism, an underactive thyroid or adrenal fatigue. Perhaps if this wasn’t the main point of the author he shouldn’t have come across so narrowly at the beginning of his article.
Over the last year or so I have been reading your blog regularly for encouragement and ideas to implement positive changes into my diet and my exercise regime.
When I read your guest’s post I fell judged, generalized and offended. I am surprised that you hosted him. There have been other times that I felt some of the ideas presented on your blog are rigid and sensationalized. For these reasons I have unsubscribed from your blog.
I wish you the best.
I’m sorry to hear that Laura. I am learning a lot from Konstantin and he is challenging some of the long held ideas I have had about weight loss myself. I like how he presents information in a new and unique way and always gets us to think. This is a complex issue that needs new and fresh ideas and perhaps his column over time may actually provide a few ideas that you can really run with.
I’m not sure I agree with the adrenal fatigue bit. Not as it relates to weight gain/loss, but rather just the condition itself and its accompanying symptoms. Can’t adrenal fatigue be seen on a continuum…with what you’re referring to as “primary and secondary adrenal insufficiency” on the more extreme end of the continuum? You mention blood testing for this condition…I’ve read numerous articles stating that blood testing for adrenal conditions is often inaccurate and the most accurate way to test is saliva testing. I myself have done 3 rounds of saliva testing of the adrenals. Initially, my cortisol levels were way too high, and particularly at times they should be low. My doctor warned that if this continues long enough the adrenals will become fatigued and unable to produce adequate cortisol. Sure enough, the next time I was tested, my cortisol levels were lower than they should be. By the third testing (after treatment with bio-identical hormones and herbal supplements) they had come back up and I was closer to the normal range. My weight has always been healthy, so I don’t necessarily feel the adrenal issues have contributed to weight problems (5’5″, 120-125lbs). But I’ve been plagued with other symptoms, many of which fit the description of adrenal fatigue. Thoughts?
(P.S. I’ll note that I think my adrenal issues are actually symptoms of a greater issue which is the health of my gut.)
Holly, elevated level of cortisol will cause a severe fatigue because it compromises the quality of your sleep, so you are rarely well-rested, even though you may sleep enough hours. Can this condition wear-and-tear the adrenal glands? I don’t know.
If I understand your response correcctly, you are saying adrenal fatigue is not a continuum, rather there is only the clinical diagnosis of “primary adrenal insufficiency” and “secondary adrenal insufficiency.” Correct? I suppose, if this is true, it can be comforting on one level, but disconcerting on another.
How could overproduction of cortisol (overactive adrenals) NOT wear-and-tear the adrenals?
I will say I like your overall position on weight issues — although I agree with some of the other comments that some of what you say seems to align with conventional medicine and contradict what we’ve learned outside of mainstream medicine, and even some of the things Sarah preaches.
Holly, please see my answers in-line:
If I understand your response correctly, you are saying adrenal fatigue is not a continuum, rather there is only the clinical diagnosis of “primary adrenal insufficiency” and “secondary adrenal insufficiency.” Correct?
— That’s what medical references are saying. I am simply repeating what I am reading there.
How could overproduction of cortisol (overactive adrenals) NOT wear-and-tear the adrenals?
— I don’t know. The body doesn’t work in the same way as mechanical devices, particularly endocrine organs. Most of the conditions discussed here are related not to wear-and-tear, but autoimmune and degenerative (tumors) conditions.
I will say I like your overall position on weight issues – although I agree with some of the other comments that some of what you say seems to align with conventional medicine and contradict what we’ve learned outside of mainstream medicine, and even some of the things Sarah preaches.
— If a person is seriously sick, the person is sick, period. I am not “aligned” with anyone, but responsible and realistic. And so is Sarah. We are both trying to help healthy people remain that way, and that has nothing to do with medicine regardless of its orientation (i.e. mainstream, integrative, alternative, etc.)
Speaking of the true definition of “health”. The word gets its roots from the word “whole” or “unified”. Hopefully our medical system will recognize that our body works in a united fashion. If we keep treating symptoms or body parts disjointed, people will never attain health.
Jeanette, I am with you 100% on that. That’s what I am trying to accomplish with my work here — weight loss/gain it isn’t just a diet, or exercise, but also your mind, your environment, your attitude, etc., etc., etc., and the best way to lose weight for good is… by making yourself “whole…” I know it sounds a bit corny and trite, but that is what it is.
Hi Konstantin,
I appreciate your direct communication. Our society is constantly fed an ideology of “go to the doctor”, “get a prescription”, etc. When I was overweight, I had depression/anxiety, no energy, frequent illness, etc. It was no easy task to change my lifestyle. Looking back, it’s almost as if I was a completely different person.
Thank you for your posts, I respect the strength it takes to provide honest information.
Anthony
Anthony,
It is my pleasure and honor to be a part of this site and this community. Yes, it isn’t easy (or profitable) to row against the current, but that’s the way Sarah, you, I, and many other contributors are… Hopefully, one day what we do will become a current! Until then, we’ll just do what we do best, and to the best of abilities.
Thank you again for your encouragement, and my congratulations on taking control of your health. The whole point of this article is exactly what you’ve just described — if you wish to take control over your health, weight, life, etc., don’t chase chimeras.
True, there are plenty of people with serious and legitimate problems, and, thanks God, most of them can still find a competent care from medical doctors.
I think that when some of us say we have a faulty metabolism, we don’t mean it in the strict medical sense. We know “something” is wrong, or likely more than one “something.” Another blogger likened all the hormonal and other processes to a “black box.” Those of us who have extreme difficulty in losing weight despite following all the rules and guidelines know there’s something wrong, we just can’t name it. That’s why we say it’s our metabolism, for example.
Also, I think that “health” is more a continuum than a well/not-well scenario. Just because someone doesn’t test positive for a certain ailment doesn’t mean that they’re not on the road to that ailment, and that if they could be treated early on instead of waiting until they reach a full-blown positive reading on a blood test, maybe they could nip it in the bud before getting that full diagnosis.
Bawdy,
You are right. I don’t take “bad metabolism” 100% literally.
You wrote: “Those of us who have extreme difficulty in losing weight despite following all the rules and guidelines know there’s something wrong, we just can’t name it.”
Please always consider that these rules and guidelines may be wrong, you are well, and just need a different set of “rules”…
Great point, by the way! Thank you!
In the African American Community being skinny is not celebrated. I have been trying to gain weight all my life and literally am disgusted at being so small. My friends of other races all love my size and think that when I complain I am doing so for attention. I try to explain to them that being curvy is something that makes you a woman. I think I may show them this article so they can see that skinny was not always something that equaled beautiful. At one point I actually hoped for a thyroid issue, my thinking was “At least that could be reversed, and I would gain weight after treatment”, but after my tested levels came back normal, I don’t know what is the blame. I guess I am one of those people with a poor metabolism.
Ebony,
If you are well and healthy, then your metabolism is perfectly normal. You are what you are because God and genetics made you that way. Just accept it, and be happy. If you would like to get curvier, weight lifting is the best option to accomplish this task — it will increase your muscle mass, your appetite, and your confidence, so you will not need to think of blame, but of what you can accomplish with what you have rather than with what you could’ve, would’ve, should’ve.
You know, I kinda like this guy. Straight forward, black and white, it is what it is–that’s my style. I think it’s time we all got real with ourselves and stopped with the excuses and supposed “conditions” we have. I see articles all the time now about “signs you have adrenal fatigue” or “why your weight gain may be thyroid related.” How do so many people suddenly have these issues? I think people want to believe that there is an issue with their bodies beyond their control, because then we don’t have to admit the truth. Food is good, we are eating too much, and too many of the wrong things. I’m guilty of this myself! I know there are people who do have legitimate issues, but for the most part, I think many of us just overindulge. I look forward to more weekly posts.
So agree with this article. We need to stop self-diagnosing and start trusting our doctors.
If I trusted my doctor and didn’t question, I would still be so sick. I HAD to push and beg, because the endocrinologist blew me off, and the doctors only cared about certain symptoms of mine instead of finding a problem that might address multiple issues I was having. I am a different person than I was 5 months ago because I pushed and questioned until they took me seriously. They wanted me on antidepressants and a bunch of other stuff, but instead I got to start taking thyroid replacement………and that took care of the other issues! No antidepressants needed now! I actually enjoy my kids and my life again. Trust doctors who are often influenced by big pharama, overbooked and rushed to get through all the patients, and who aren’t living in my skin and experiencing what is going on in me? No thanks. No doctor knows everything.
Heidi,
It is very sad that paying patients have to beg for proper treatment. The system is seriously sick when you can’t get help from a specialist in this field. I am glad you have found the right doctor, and are back “on-line.”
Now I have officially heard it all!
I heard Dr. Jerry Tennant speak at the last WAPF conference and bought his book Healing is Voltage. In his book he addressed the inaccuracy of the thyroid tests and how someone can have a thyroid issue but normal test results. This is especially true if the person has consumed fluoride. Dr. Tennant’s book (although not the easiest read due to formatting and style) is excellent. I wish I had the book here to quote and reference the section on the thyroid and why the test is not as accurate as Konstantin Monastyrsky would have us believe, but both my copies of the book are currently lent out.
Barbara,
We are addressing two completely different issues. Being trained as a chemist, here is what I can tell you about the accuracy of these tests: when done right, they are 100% accurate. If in doubt, just do another one with a different doctor and clinical lab.
I don’t think we are addressing two completely different issues. Dr. Tennant explains in his book what doctors are trained to look for and why the tests aren’t accurate. He has an entire chapter in his book related to this issue. It’s definitely worth looking at. I don’t need to be a chemist to know a paradigm shift in the way we view information or the revelation of new information, can completely change all the “facts” that someone thought they knew.
I think 10% with hypothyroidism is high. That is 10 out of 100 women. And how many out there are not diagnosed? I have Hashimotos. My daughter has Hashimotos (At 12 her tsh was in the 90’s and it was already affecting her heart). My aunt has Hashimotos. My mother had Graves disease. My mother in law was hypothyroid and my grandmother (don’t know about Hashimotos because they probably weren’t tested). I know lots of friends with it. I know woman who haven’t gotten pregnant because of thyroid problems. All of the above were young or middle age when diagnosed. It is real.
Kristin, 10% refers to women who are mostly over 65 with subclinical hypothyroidism, meaning their blood test demonstrates a low range of relevant hormones for their age group, but they don’t display any clinical symptoms of hypothyroidism.